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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000001

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Florence JeanJohnson Sex Female

Date of Birth June 17, 1920 Place of Birth River JohnCounty of Pictou

Name of Father Daniel Johnson MAIDEN NAME of Mother Jemima Jane Innis

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born River John Present address of Father River John

Occupation of Father at Birth of child Farmer Place of birth of Father Back Shore, River John

Race Scottish Name and present address of Physician in attendance at birth Dr. D.A. Murray, River John

Signature of Applicant Mrs. Florence Johnson Graham Address of Applicant 247 Archimedes St. Date November 30, 1946

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Florence JeanJohnson

Born at River John in the County of Pictou

That Florence JeanJohnson Whose Birth is sought to be registered was

born at River John Pictou County on June 17, 1920

My knowledge of the fact and date of such Birth is based on the following Circumstances:

Father of said Florence Jean Johnson

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